* Connected Within: The group will have an ambulatory EHR, designed and used actively by physicians and their support staff. The EHR will work with practice management, billing, data mining and data reporting systems, along with other ancillary systems such as an in-house lab. Features in the EHR include standardized documentation screens linked to established vocabulary standards, such as LOINC, and SNOMED, with fluent translation to ICD-10. A patient portal is a must and it must be so well-designed that patients with chronic conditions visit it as often as a teenager visits Facebook (I exaggerate slightly as I realize no Web site could live up to that standard).
* Connected Without: The group will have bi-directional feeds to a variety of trading partners, including local hospitals, long-term care facilities, pharmacies, imaging centers, labs, referring physicians (see note on size), state data registries, their payers, and above all, CMS.
* Size: The group will be big enough to generate margins to pay for all this technology, but not so big it will become burdened by its own bureaucracy. In other words, just right.
* Multi-specialty: The group will either contain specialists in the areas of obstetrics and gynecology, cardiology, orthopedics, pediatrics, oncology, endocrinology and whatever other services are most in demand in their market area, or have close relationships with other group practices in those areas who they both trust and whose relative cost and quality they know. An imaging center would help.
* Deep Financial Bench: The practice needs a person well-versed in cost accounting, payer contracting, trends analysis, at-risk reimbursement models such as bundled payment and fee-for-service withholds, and advanced algebra with a dose of predictive modeling thrown in. This person also needs to speak English and be able to relate these ideas to those taught in medical school.
* Deep I.T. Support Bench: The practice needs a person with the ability to design, write and maintain interfaces to a variety of information systems both inside and outside the practice (see item above). This person will need a good memory as they will need to recall on demand the ICD-10 remediation schedules for the suppliers of these various systems and quote the related price if the remediation falls outside the scope of their current service agreement.
* Coding and Physician Documentation Expert with No Outside Life. This person will understand CPT and ICD-10 and quote chapter and verse on what every payer in the practice’s business requires to substantiate them. This person will double as compliance and privacy officer and keep tabs on how the practice’s business associates store and use any protected health information they may have received from the practice. They also need to know how to do a remote data wipe-out in case Dr. Smith loses his smart phone and happened to have patient data stored on it. Either that or they will need the people skills to convince the I.T. guy to do it.
* Apathetic Local Media: In case the practice is compelled by HHS to report a data breach to the media, knowing that the local newspaper will bury the news behind the sports section will be reassuring.
* Emergency Consultant Fund: The practice needs a healthy reserve to hire consultants in the areas of practice management, care coordination, finance, I.T. and coding in case someone calls in sick or opts for another line of work. This reserve should equal approximately four years’ operating expenses or enough to see the practice through to the next presidential election.